systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.38109/2075-082X-2022-3-41-47systhiper-16Research ArticleОБЗОРREVIEWНеконтролируемая артериальная гипертензия и синдром обструктивного апноэ сна: комплексный подход к лечениюUncontrolled hypertension and obstructive sleep apnea: integrated treatment approachhttps://orcid.org/0000-0002-3609-2504МихайловаО. О.MikhailovaO. O.

Михайлова Оксана Олеговна, к.м.н., научный сотрудник лаборатории апноэ сна отдела гипертонии

ул. 3-я Черепковская, д. 15а, г. Москва 121552

Oksana O. Mikhailova, Cand. Sci. (Med.), Researcher of the Sleep Laboratory, Hypertension Department

3rd Cherepkovskaya str., 15a, Moscow 121552

ox.mik@mail.ruhttps://orcid.org/0000-0001-9623-9187ГогиберидзеК. О.GogiberidzeK. O.

Гогиберидзе Кристина Олеговна, ординатор отдела гипертонии

ул. 3-я Черепковская, д. 15а, г. Москва 121552

Kristina O. Gogiberidze, resident of the Hypertension Department

3rd Cherepkovskaya str., 15a, Moscow 121552

https://orcid.org/0000-0002-3140-5030ЕлфимоваЕ. М.ElfimovaE. M.

Елфимова Евгения Михайловна, к.м.н., старший научный сотрудник лаборатории апноэ сна отдела гипертонии

ул. 3-я Черепковская, д. 15а, г. Москва 121552

Evgeniya M. Elfimova, Cand. Sci. (Med.), Senior Researcher of the Sleep Laboratory, Hypertension Department

3rd Cherepkovskaya str., 15a, Moscow 121552

https://orcid.org/0000-0001-5918-9969ЛитвинА. Ю.LitvinA. Yu.

Литвин Александр Юрьевич, д.м.н., главный научный сотрудник отдела гипертонии, руководитель лаборатории апноэ сна отдела гипертонии; профессор кафедры поликлинической терапии лечебного факультета

ул. 3-я Черепковская, д. 15а, г. Москва 121552

ул. Островитянова, д. 1, г. Москва 117997

Alexandr Yu. Litvin, Dr. Sci. (Med.), Prof., Chief of the Sleep Laboratory, Hypertension Department; professor of the department

3rd Cherepkovskaya str., 15a, Moscow 121552

Ostrovitianov str. 1, Moscow, 117997

https://orcid.org/0000-0002-9822-4357ЧазоваИ. Е.ChazovaI. E.

Чазова Ирина Евгеньевна, академик РАН, профессор, д.м.н., руководитель отдела гипертонии, заместитель генерального директора по научноэкспертной работе

ул. 3-я Черепковская, д. 15а, г. Москва 121552

Irina E. Chazova, Dr. Sci. (Med.), Prof., Acad. RAS, Chief of the Hypertension Department

3rd Cherepkovskaya str., 15a, Moscow 121552

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Министерства здравоохранения Российской ФедерацииРоссияE.I. Chazov National Medical Research Center of CardiologyRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Министерства здравоохранения Российской Федерации; Федеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияE.I. Chazov National Medical Research Center of Cardiology; Pirogov Russian National Research Medical UniversityRussian Federation2022171220221934147Copyright © Михайлова О.О., Гогиберидзе К.О., Елфимова Е.М., Литвин А.Ю., Чазова И.Е., 20222022Михайлова О.О., Гогиберидзе К.О., Елфимова Е.М., Литвин А.Ю., Чазова И.Е.Mikhailova O.O., Gogiberidze K.O., Elfimova E.M., Litvin A.Y., Chazova I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/16

Достижение целевых цифр артериального давления (АД) является основной целью при лечении артериальной гипертонии (АГ), поскольку ведет к снижению сердечно-сосудистого риска. Известно, что должный контроль уровня АД достигается менее чем в половине процентов случаев. Кроме того, в популяции пациентов с АГ есть фенотипы, при которых уровень АД особенно трудно контролировать, что еще более повышает риск сердечно-сосудистых осложнений. В частности, речь идет о так называемой неконтролируемой АГ, а именно – ее резистентной (РАГ) и рефрактерной (РФГ) формах течения.

Недавние результаты исследований свидетельствуют о том, что РАГ может быть связана с изменениями в ренин-ангиотензин-альдостероновой системе, в то время как РФГ, по-видимому, более тесно связана с симпатической гиперактивацией. Эти патофизиологические механизмы также активируются у пациентов с синдромом обструктивного апноэ сна (СОАС). Поэтому неудивительно, что распространенность СОАС у пациентов с РАГ и РФГ очень высока, а лечение постоянным положительным давлением в дыхательных путях (ПАП-терапия) позволяет клинически значимо снизить уровень артериального давления у пациентов обеих групп. Последнее позволяет рассматривать ПАП-терапию как дополнительное средство достижения целевого уровня АД у пациентов с неконтролируемой АГ и СОАС.

The main goal in the arterial hypertension (AH) management is the target blood pressure (BP) achievement, as it leads to the cardiovascular risk reduction. At the same time, proper BP is achieved less than in 50% of all cases. In addition, there are two types of truly uncontrolled AH in population, such as resistant (RAH) and refractory (RFH) AH.

Recent research suggests that RAH may be associated with changes in the renin-angiotensin-aldosterone system, while RFH appears to be more closely associated with sympathetic hyperactivation. These pathophysiological mechanisms are also active in patients with obstructive sleep apnea (OSA). Therefore, the prevalence of OSA in patients with RAH and RFH is very high, and treatment with continuous positive airway pressure (PAP-therapy) can reduce BP levels in such patients. The latter allows us to consider PAP-therapy as an additional method for the target BP achievement in patients with uncontrolled AH and OSA.

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The authors declare that there are no conflicts of interest present.